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Biomedical subjects

A H Wilde

Publications and source records attributed to A H Wilde.

At least 19 recordsLinked to original sources
PubMed1992

Capitellocondylar total elbow replacement. A long-term follow-up study.

Fifty-one capitellocondylar elbow replacements were inserted in forty-one patients between 1976 and 1986. Thirty-nine patients had rheumatoid arthritis and two had traumatic osteoarthrosis. The average age of the patients at the time of the operation was fifty-six years (range, twenty-one to seventy-seven years). Thirty-one patients who had thirty-nine retained elbow prostheses had an average length of follow-up of 6.5 years (range, two to thirteen years). Flexion improved an average of 20 degrees; extension, 4 degrees; pronation, 22 degrees; and supination, 36 degrees. Relief of pain was complete in 85 per cent of the thirty-nine elbows, and in 15 per cent there was only mild pain. Noteworthy postoperative complications in the original fifty-one elbows included infection in four elbows (8 per cent), dislocation in three (6 per cent), and ulnar neuropathy in sixteen (31 per cent). Three elbows were revised: one for a humeral fracture, one for recurrent dislocation, and one for aseptic loosening. Aseptic loosening was evident on radiographs of two elbows; one patient was completely asymptomatic, and one had mild pain with deformity. The Souter zonal radiographic assessment system for identification of radiolucencies at the bone-cement interface was utilized; there was no significant difference in radiolucencies between ulnar components backed with metal and those that were not backed with metal. Kaplan-Meier cumulative survivorship analysis demonstrated that a functional prosthesis was retained in 88 per cent of the elbows at 1.4 years postoperatively and in 83 per cent at 5.5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Preoperative nutritional status of total joint patients. Relationship to postoperative wound complications.

The records of 217 consecutive patients who underwent a primary total hip or total knee arthroplasty were reviewed for preoperative and postoperative nutritional status. Fifty-seven patients had a lymphocyte count of less than 1,500 cells/mm3, four patients had an albumin level of less than 3.5 g/dL, and two patients had both, giving a 27% incidence of indices indicative of preoperative nutritional depletion. Patients without wound complications had an average preoperative lymphocyte count of 1,995 (+/- 631), compared to 1,638 (+/- 491) for those with persistent serous drainage from their wounds, and 1,553 (+/- 419) for those patients with a major wound complication (P = .002). The average albumin levels were 4.30 (+/- 0.33), 4.22 (+/- 0.31), and 4.13 (+/- 0.54), respectively. Patients with rheumatoid arthritis were compared to those with osteoarthritis and were found to have significantly lower preoperative albumin levels. They were three times as likely to develop a major wound complication. Patients on immunosuppressive medications had significantly lower preoperative lymphocyte counts, lower albumin levels, and higher complication rates (P = .04). After operation, lymphocyte counts of all patients dropped to an average of 57% of their preoperative values, and albumin levels dropped to 72% of their preoperative values. No nutritional parameters had returned to their preoperative levels by 10 postoperative days. For all patients, a preoperative lymphocyte count of less than 1,500 cells/mm was associated with a five times greater frequency of developing a major wound complication, and an albumin level of less than 3.5 g/dL had a seven times greater frequency.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

The incorporation of tibial allografts in total knee arthroplasty.

Twelve knees in ten patients had revision total knee replacement with insertion of an allograft for a large tibial defect. The knees were retrospectively evaluated at an average of thirty-two months (range, twenty-five to fifty-one months) by clinical examination, radiography, planar bone scintigraphy, and single-photon-emission computed tomography. The average age of the patients was sixty-two years (range, fifty-four to seventy-nine years). A constrained total-condylar prosthesis was used for all revisions. A contained tibial defect was present in five knees, and seven knees had an uncontained defect that was treated with a massive composite structural allograft, five of which were secured with internal fixation. The knee scores improved from an average of 51 points before operation to an average of 87 points post-operatively. Seven knees had a score of 85 points or more and were considered to have an excellent clinical result. Two knees had a good result, with scores of 77 and 72 points. One knee had another revision because of painful non-union of a medial structural graft, and the result in that knee was considered a failure. The average range of motion improved from 84 degrees to 105 degrees. There were no deep infections, and no graft showed evidence of fracture or collapse. Radiographs demonstrated complete incorporation of the graft in eleven of the twelve knees at an average of twenty-three months after operation. Single-photon-emission computed-tomography scans showed uniform activity in the area of the graft in four of the five knees that were studied.

Aged↗
PubMed1989

Intramedullary fixation for arthrodesis of the knee after infected total knee arthroplasty.

Knee arthrodesis with curved intramedullary rods was performed in 12 patients after infected total knee arthroplasty. The underlying pathologic condition was osteoarthritis in nine patients and rheumatoid arthritis in three patients. Nine patients with a postoperative follow-up time of greater than two years (average, 34 months; median, 29 months; longest, 55 months) were evaluated for functional results. Six patients obtained a satisfactory knee fusion in an average of 6.6 months (range, three to 11 months; median, five months). Those patients without massive bone loss preoperatively attained a fusion rate of 66.6%. Two thirds of the patients with massive bone loss attained fusion. Indications for surgery in addition to infection included massive bone loss, mixed infection with multiple organisms, infrapatellar tendon rupture, ligamentous instability, and severe valgus deformity with tibial fracture nonunion. Failure occurred in three cases. One was associated with rod breakage; another was due to massive bone resorption; and the third was in a diabetic female with infrapatellar tendon rupture. All patients with successful arthrodesis reported an absence of pain and the ability to ambulate with, at most, a walker. The use of curved intramedullary rods is a convenient technique for obtaining successful arthrodesis after infected total knee arthroplasty.

Aged↗
PubMed1988

Hematogenously acquired infection of a total knee arthroplasty by Clostridium perfringens.

A 64-year-old man with total knee arthroplasty for tricompartmental osteoarthritis had a postoperative course complicated by an attack of acute cholecystitis and was treated with cholecystectomy. The TKA was hematogenously seeded with Clostridium perfringens, which necessitated emergency removal of the implants, debridement, and ultimately arthrodesis.

Acute Disease↗
PubMed1988

Two-stage reimplantation in infected total knee arthroplasty.

Twenty-one infected total knee arthroplasties (TKA) in 21 patients were treated from September 1980 through October 1987. Of these, 15 were followed for more than one year. Treatment of these patients consisted of thorough debridement of all infected tissue and components; a cement spacer was used in ten patients. The cement was impregnated with antibiotics. This procedure was followed for an average of 4.2 weeks with intravenous antibiotics and TKA utilizing antibiotic-impregnated cement. Five patients had rheumatoid arthritis and ten had osteoarthritis. The organisms included Staphylococcus coagulase negative (seven patients), Streptococcus group B (two patients), Streptococcus bovis (one patient), Enterococcus (one patient), Staphylococcus coagulase positive and Bacillus circulans (one patient), Staphylococcus coagulase negative and Enterococcus (one patient), Staphylococcus coagulase negative and Pseudomonas aeuriginosa (one patient), and Clostridium perfringens (one patient). Of the 15 patients, 12 appeared to be free of infection, two were obvious failures and required knee fusion, and one was suspected of having continued infection at five years and was treated elsewhere. Eleven patients with revision TKA were available for follow-up examinations at an average of 2.9 years (range, one to six years). One patient died five years after reimplantation but had been functioning well. One patient functioning at three years postreimplantation did not return for a later follow-up examination. The average knee score (modification of the Hospital for Special Surgery Knee Score) was 75.5 points (range, 48-94); average flexion was 81 degrees (range, 52 degrees-120 degrees), and average extension was +6 degrees (range, 0 degrees-30 degrees).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Infection with Candida albicans of a total knee arthroplasty. Case report and review of the literature.

Infection with Candida albicans of a total knee arthroplasty developed in an immunosuppressed 52-year-old woman with rheumatoid arthritis who initially presented with clear drainage from the incision, which cultured negative initially. Successful treatment consisted initially of debridement and a course of intravenous antibiotics, followed by staged arthrodesis with an intramedullary rod.

Anti-Bacterial Agents↗
PubMed1987

Capitellocondylar total elbow arthroplasty. Two-to eight-year experience.

A series of 35 capitellocondylar total elbow arthroplasties was performed on 29 patients. The average patient age at the time of surgery was 58 years (range, 28-71 years). Follow-up study averaged 5.6 years (range, 2-8 years). The complication rate was 57%. There were three infections, three dislocations, and two intraoperative fractures. Transient ulnar nerve palsy occurred in nine patients, postoperative hematomas in two patients, and intraoperative perforation of the ulna cortex in one patient. Aseptic loosening occurred around the humeral component of one elbow. No ulnar components developed aseptic loosening. Range of motion increased in all planes, except extension. Pain relief was achieved in all but one patient. There were no unstable elbows.

Adult↗
PubMed1986

Allograft reconstruction of the acetabulum during revision total hip arthroplasty. Clinical, radiographic, and scintigraphic assessment of the results.

In twenty-one hips of twenty-one patients, the acetabulum was reconstructed using allografts during revision of a total hip arthroplasty. The patients' average age at the time of revision was 64.3 years (range, nineteen to eighty-six years). At an average follow-up of 3.5 years (range, two to five years), three patients had died of causes unrelated to the hip reconstruction, and one had been lost to follow-up. In the other seventeen, the average Harris hip rating was 89 points (range, seventy to 100 points) at follow-up. In one patient the allograft collapsed, so that revision was required. Two patients had asymptomatic progressive radiolucencies at the cement-bone interface of the reconstructed acetabulum, and another had a 1.5-millimeter-wide lucency at the interface of the donor and recipient bone but was asymptomatic, and there had been no change in the position of the cemented acetabular component since operation. The remaining grafts appeared to be incorporated securely, as determined by radiographic examination. Three-dimensional computerized tomographic radioisotopic bone scans showed uniform uptake, consistent with revascularization and new-bone formation, in all grafts. There was no radiographic evidence of focal avascularity and there were no infections. Femoral-head bone allografts appear to provide a useful technique for the reconstruction of a severely deficient acetabulum during revision total hip arthroplasty.

Acetabulum↗
PubMed1982

A ten-year follow-up of one hundred consecutive Müller curved-stem total hip-replacement arthroplasties.

One hundred consecutive Müller curved-stem total hip replacements were reviewed ten years after operation. Twenty patients with twenty-two arthroplasties had died within the ten-year period without having a revision, and twenty-five arthroplasties had been revised for various reasons. Of the remaining fifty-three arthroplasties, thirty-five were classified as good or excellent, with Harris hip scores of 80 points or higher, and eighteen were classified as poor or fair, with scores lower than 80 points. Follow-up radiographs, made for all but six of the fifty-three hips at ten years, showed a 23 per cent incidence of migration of the acetabular component and a 28 per cent incidence of migration of the femoral component. In addition, there was a 15 per cent incidence of bone resorption in the proximal end of the femur without migration of the femoral component and a 4 per cent incidence of osteolytic defects about the femoral component, also without migration. Combining the radiographically loose replacement (migration) with the clinically loose ones (revised), the over-all incidence of aseptic loosening was 29 per cent for the acetabular component and 40 per cent for the femoral component. There was a positive correlation between the incidence of loosening of the femoral component and younger age, heavier weight, male sex, unilateral hip disease, a wide femoral canal, and varus position of the femoral component, whereas the incidence of loosening of the acetabular component was increased only in association with older age. The rate of loosening of the femoral component appeared to be higher during the early follow-up period and to decrease with time, while the rate of loosening of the acetabular component appeared to be lower during the early follow-up period but to increase with time.

Adult↗
PubMed1978

Points in the technique of recementing in the revision of an implant arthroplasty.

When aseptic failure of the bond between the cement and the prosthesis of a total joint replacement occurs, complete removal of the cement has been advocated before the insertion of a new prosthesis. The present study questions this practice. Both laboratory tests on variously prepared specimens of cement and clinical experiences demonstrate that recementing over old cement is a practical alternative if the technique employed includes the removal of blood from the old cement surface, rasping of this surface and the early application of fresh cement.

Arthroplasty↗
PubMed1977

Herbert total knee prosthesis: combined laboratory and clinical assessment.

We tested the Herbert knee prosthesis, which was designed to restore intrinsic stability with limited degrees of freedom for rotation to severely damaged or deformed knees, in a knee simulator. These tests indicated a tendency for the prosthesis to fracture through the medial femoral housing after cycling for the equivalent of one to three years of normal use. In a clinical series of thirty-five knees treated with the prosthesis, there were five failures similar to those produced by laboratory testing. On the basis of this combined study, the Herbert prosthesis appears to have design characteristics that seriously limit its usefulness for long-term knee replacement. Testing in a knee simulator in this case appeared to be a valid predictor of clinical failure.

Biomechanical Phenomena↗